Health blogger Kevin Pho, M.D., wrote recently about radiation risk from CT scans, and how the “best way to help curb the rampant ordering of these tests” is by educating patients about the radiation stemming from the tests. Pho cites an Annals of Emergency Medicine study finding that patients underestimate their radiation risk (no surprise there), disagreeing with the statement that CT scans would up their cancer risk, and ¾ not understanding the differences in radiation between CT scans and traditional chest x-rays. Pho writes:

“The best we can hope for is to explain to patients the risks and benefits of ordering such scans, and together come up with a shared, informed decision. Of course, our health system isn’t set up for such conversations. There is much more incentive — from a reimbursement, malpractice, and customer service standpoint — to simply order the test.”

I agree with Pho on his point that educating patients about the radiation risks involved in ordering CT scans is of utmost importance, but we must balance this concern about radiation with making sure patients get the tests that they need to diagnose and treat a life-threatening condition.  Cardiovascular disease continues to be the number one cause of morbidity and mortality in the U.S. Meanwhile, risk of cancer due to radiation exposure, although a real problem, must be properly balanced against the benefits of our imaging technologies.

Because of the delicate balance that must be maintained, the ACC has taken a multi-pronged approach to ensuring radiation safety, including:

1. Setting standards through laboratory accreditation programs, appropriate use criteria (AUC), clinical practice guidelines, and other standards documents;
   
   
2. Developing requirements for training programs and competency, including how to minimize radiation doses during testing and procedures; and
   
   
3. Implementing quality improvement programs aimed at lowering the dose for each scan or procedure performed. Approaches to minimizing doses include using AUC to eliminate unnecessary scanning procedures; following the principle of "as low as reasonably appropriate" with respect to radiation levels; displaying dose information wherever studies are done; and encouraging facilities to monitor delivered doses and compare them with benchmarks.

Combining these three approaches with patient education is the best way that we can reduce radiation risk while still making sure patients get needed tests. Maybe the only way.

Check out Pho’s full post here. For more on ACC’s views on radiation safety, read a JACC’s President Page I wrote with ACC leader Pam Douglas, MD, FACC.